Birthday cake. Pizza. Chocolate chip cookies. For people with celiac disease, a
lifelong disorder of the digestive system, these foods aren't always the treats
that most people think they are. Why? Because they usually contain a type of protein
called gluten, which causes problems for people with celiac disease.

What Is Gluten?

Gluten (pronounced: GLOOT-in) is the common term for a group of proteins found
in wheat, rye, barley, and grains derived from them or having different names like
triticale, durum, kamut, semolina, and spelt. Grains are so common in our diet that
gluten is second only to sugar as our most commonly consumed ingredient.

What Is Celiac Disease?

The digestive system is the set of
organs that digest food and absorb the important nutrients the body needs to stay
healthy and grow. One important part of the digestive system is the small intestine,
which is lined with millions of microscopic, finger-like projections called villi
(pronounced: VIL-eye). Nutrients are absorbed into the body through the villi.

People who have celiac (pronounced: SEE-lee-ak) disease have a disorder that makes
their bodies react to gluten. When they eat gluten, an immune system reaction to the
protein gradually damages the villi in the small intestine. When the villi are damaged,
the body can't absorb the vitamins, minerals, and other nutrients it needs to stay
healthy. People with celiac disease are therefore at risk of malnutrition
and can develop anemia (a decreased number of
red blood cells due to lack of iron) or osteoporosis (brittle bones from lack of calcium).

The body's inability to absorb nutrients can mean that young people with untreated
celiac disease may not grow properly and might lose weight and be very tired. They
also might be prone to developing other diseases, such as thyroid
disease, type 1 diabetes, and gastrointestinal
cancer.

What Causes It?

Experts don't know exactly why people get celiac disease, which is also called
gluten intolerance, celiac sprue, nontropical sprue, or gluten-sensitive enteropathy.

The disease has some genetic background, which means that it may run in families.
Just like eye or hair color, people inherit the genes that make them more likely to
get celiac disease from their parents and grandparents. If an immediate family member
(such as a parent or a sibling) has celiac disease, there's about a 5% to 10% chance
that you could have it, too. Celiac disease affects people of all heritages and backgrounds.

It is estimated that 1 in 133 people in the United States has the condition,
although many don't know that they do.

Signs and Symptoms

It's important to diagnose celiac disease early before it causes damage to the
intestine. But because it's easy to confuse the symptoms with other intestinal disorders,
such as irritable bowel syndrome,inflammatory bowel disease, or
lactose intolerance, teens with celiac disease may not know they
have it.

Some common symptoms of celiac disease are diarrhea, abdominal pain and bloating,
and weight loss. Someone with the disease may feel tired and could be irritable or
depressed. Some have skin rashes and mouth sores. Teens with undiagnosed celiac disease
may go through puberty late.

Someone might not show any symptoms until going through an emotionally or
physically stressful event, such as going away to college, illness, or an injury or
pregnancy.

How Is Celiac Disease Diagnosed?

Because the symptoms of celiac disease are similar to some other digestive conditions,
only a doctor can tell for sure if a person has the disease. First the doctor will
do a medical history, where he or she will ask you about any concerns
and symptoms you have, your past health, your family's health, any medications you're
taking, any allergies you have, and other issues. In addition to doing a medical history,
your doctor will do a physical examination.

If a doctor suspects someone has celiac disease, ordering a blood test is
usually a first step in diagnosing the disease. If the results of the blood test show
a high level of antibodies to gluten and to certain other proteins in the intestinal
lining — a sign that the person could have celiac disease — then the doctor may order
a
biopsy
of the small intestine
to confirm the diagnosis.

In the case of celiac disease, doctors take a tissue sample from the small intestine
by inserting a long, thin tube called an endoscope through the mouth
and stomach into the small intestine. A person is fully or moderately sedated
during this procedure. In many cases, doctors use general anesthesia to put the
patient to sleep. The sample is sent to a laboratory for testing.

How Is It Treated?

Once celiac disease is diagnosed, a doctor will help treat it. Although there is
no cure, celiac disease can be managed successfully by following a gluten-free diet.
People with celiac disease need to follow this diet for life. Because gluten
can be found in everything from breakfast cereals to prepared luncheon meats, they
need to be very aware of what's in the foods they eat.

If you've been diagnosed with celiac disease, a doctor or dietitian who specializes
in celiac disease can help you develop an eating plan that works with your lifestyle.

Luckily, the small intestine can heal. Although this can take up to a year, many
people start to feel better after just a few days on a gluten-free diet. But feeling
better doesn't mean that people with celiac disease can eat foods containing gluten
again. The genes that cause the disease are in the body and the immune system continues
to react to gluten, so the symptoms and problems will return if someone with celiac
disease starts eating gluten again.

Taking Care of Yourself

The good news about celiac disease is that many favorite foods, like birthday
cake and pizza, can be prepared without gluten. So if you have celiac disease, you
can still find ways to enjoy most of your favorite foods — you just need to do some
research and be aware of what's in them.

Find alternatives to wheat, barley, and rye flours and other gluten-containing
grain ingredients for your recipes.

Find a support group where you and other people with the condition can share
up-to-date information.

While a law requires the labeling of wheat-free products, be aware that "wheat-free"
doesn't necessarily mean "gluten-free," as wheat-free products may
have barley and rye (gluten-containing grains) in them.

Eating Away From Home

If you have celiac disease, you don't have to limit yourself to eating at home.
With experience and knowledge, you'll be able to figure out which dishes at restaurants
or friends' homes contain gluten. Some restaurants in your town might offer gluten-free
dishes on their menus.

Your local support group may have a list of restaurants where the chef is familiar
with the gluten-free diet. Ask at restaurants or consult your dietitian or a celiac
disease support group for this type of information.

Sometimes, no matter how well prepared you are, you might not be able to find out
if a particular food is gluten-free. When in doubt, leave it out!

Here are some tips to remember when choosing foods for celiac disease:

Start with the foods you can eat. Foods and ingredients
that you can eat and use in cooking include: foods made with the flours of corn, rice,
buckwheat, sorghum, arrowroot, garbanzo beans (chickpeas), quinoa, tapioca, teff,
and potato (provided other ingredients in your recipe do not contain gluten). You
can also eat all plain meat, fish, chicken, legumes, nuts, seeds,
oils, milk, cheese, eggs, fruits, and vegetables.

Be on the lookout for possible cross-contamination. Even when
eating or preparing foods that are gluten-free, if these foods come into contact with
foods that contain gluten, you run the risk of something called cross-contamination.
For example, crumbs from regular wheat bread can find their way into jams, spreads,
or condiments if people aren't careful to use a fresh knife or utensil each time.
Keeping condiments in squeezable bottles or using separate jams and spreads is a great
idea for people with celiac disease. It's also a good idea to keep a separate toaster
for gluten-free bread.

If someone in your family bakes with products that contain gluten, you need to
thoroughly clean appliances, utensils, and work surfaces before preparing your gluten-free
products. Remember to wash your hands thoroughly and often.

If a food-making environment is not a dedicated gluten-free environment, there's
a potential for contamination. For example, gluten-free bread made in a bakery that
also produces regular products might be contaminated. This can happen when machinery
is not properly cleaned between the making of gluten-containing and gluten-free
products. Some manufacturers are now making products in gluten-free environments.

Foods and Ingredients to Avoid

A U.S. law helps make checking labels for gluten a bit easier. All food labels
are required to clearly state if the food contains any of the top eight food
allergens, including wheat. However, wheat-free doesn't mean gluten-free.
Lawmakers are working to make labels easier for people with celiac disease by
requiring companies to identify other components, such as hidden ingredients and barley
and rye.

Still, it helps to know the foods to avoid. These include:

beer and other grain-based alcohol products

bouillon and broths

breading (such as the coating on breaded chicken cutlets, etc.)

brown rice syrup (often made from barley)

cake flour (made from wheat)

caramel color (occasionally made from barley)

communion wafers

couscous

creamed or breaded vegetables

dextrin (a rare ingredient, which may be made from wheat; maltodextrin is OK
for people with celiac disease)

soy sauce and soy sauce solids (they may be fermented with wheat; don't eat them
unless you verify they're OK with a dietitian)

spreads, soft cheeses, and dips

stuffings

thickeners

udon noodles

wheat-free products (wheat-free does not mean gluten-free; many wheat-free cookies
and breads contain barley or rye flour, which contains gluten and other gluten-containing
ingredients)

yogurts with wheat starch

Finding Gluten-Free Foods and Ingredients

Most grocery stores carry some gluten-free products these days. You might be able
to find gluten-free bread, cereal, baking mixes, cookies, and crackers at your local
market. For a wider selection, make a trip to a health food store. Be aware that lots
of natural markets and health-food stores keep foods in bulk bins. It's not a good
idea to use even gluten-free products from these bins because the risk of cross-contamination
is very high.

Many specialty shops online also sell a range of gluten-free products, such
as bread, pizza crusts, and pastas. Many regular and online shops even sell gluten-free
flour blends that you can use to make your own pancakes and waffles, pizza dough,
cookies, and brownies.

Eating a gluten-free diet is a lifelong commitment. But if you have celiac
disease, you are not alone. Lots of support groups, cookbooks, and websites are dedicated
to living a gluten-free life. A word of caution, though: What experts know about celiac
disease is developing so rapidly that many books and sites are out of date.

To make sure you always have the most current and accurate information, consider
joining one of the national celiac organizations. There are even gluten-free summer
camps and special support groups just for kids and teens.